Improvement projects
hospital’s main CSSD unit. While this added to decontamination turnaround times, additional staff were rostered to the area for the duration of the project, to reduce the impact of this as far as reasonably achievable. The next challenge came in the way of unexpected medical air supply lines that had been hidden in the wall between the CNS office space and the original decontamination room. A team from the local technical services department carried out an investigation and determined that this line had originally been installed as the office space was originally used for minor dental procedures. The teams’ investigation also found, unfortunately, that this supply was joined to the medical air supply for the Accident & Emergency department. To remove this air supply line, the supply to Accident & Emergency would need to be turned off for approximately two hours. A number of meetings were held to discuss
potential impacts of this and, thankfully, a plan was devised that would allow for the removal of this supply line. To accomplish this, the hospital’s medical gas supply company was contacted and individual bottles of oxygen were procured, in sufficient number, to be able to supply oxygen to all patients in Accident & Emergency. The department activity was measured for the
previous three months to ascertain if there were any trending moments that might be suitable to perform these works. A two-hour window was selected on a Tuesday evening. Patients were all supplied with the oxygen required and the works commenced on closing off the air line. Thankfully, the preparation for this aspect of the project paid dividends and works were completed in just over one hour. Normal supply was returned to Accident & Emergency without issue and the project team could focus on the next stages of construction in ENT.
New ENT decontamination rooms Initial works undertaken largely centered around water supply, air supply, drainage and electrical (including network points) in both rooms. Measurements were also taken for the space required for two pass-through washer disinfectors and the adjoining wall was cut to allow for these machines to be installed. Once the dirtier building works had been
completed, the rooms really began to take shape. All the walls were covered in white rock to provide an easy-to-clean wall surface going forward. The washer disinfector space was portioned with a false wall, featuring a white rocked surface, to allow one washer installation to take place during project, and so that it could be easily removed at a later date for the second washer to be installed. Once the walls
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were completed, the new ceiling was hung and lighting panels installed to provide good light for inspection of endoscopes in both the clean and dirty decontamination rooms. Non-slip, colour- specific flooring was then installed in both areas; red flooring in the dirty decontamination space and green flooring on the clean side. Hand hygiene sinks came next, followed
by a bespoke, height adjustable, temperature controlled, stainless steel sink for manual cleaning of the endoscopes complete with automatic detergent dosing. At this point, the rooms were ready for
machinery to be installed. The next steps saw the installation of one washer disinfector and two LTS Sterrad NX units. IQ/OQ/PQs were performed over the next couple of weeks, while the remaining workbenches and storage cabinets were installed. Two rounds of deep cleaning were provided
by the hospital’s contract cleaning services and, with that, the room was signed off by an Authorised Engineer for Decontamination as being fit and ready for use. A follow up audit was conducted, once all the decontamination machinery had been installed, and validation and commissioning works were completed, using the same framework guides that the HIQA had previously used to assess the service. The completed project saw the decontamination service rise from a compliance rate of 20%, at initial audit, to 100% compliance. The full list of things that were improved
included: l Used scopes could be transported to decontamination room without passing through clinical area.
l Fully compliant pass-through model from clean to dirty in line with National Standards.
l Fully cleanable surfaces (walls, shelving, storage & flooring).
l Newly installed height adjustable, temperature-controlled, stainless steel sink.
l New HEPA filtered air supply to clean decontamination area
l Newly installed RO plant, supplying one new washer disinfector.
l Two newly installed Sterrad NX systems. l Rollout of an electronic traceability system for decontamination practices, improving auditing ability and compliance with National Standards.
l The decontamination process is now in line with practices applied in CSSD to RIMD, providing all patients with fully traceable, sterile, flexible endoscopes for every procedure in ENT.
l Improvements in Quality Assurance practices as the Sterrad NX system utilises a biological indicator for each cycle undertaken.
About the author
Kevin Owens is the Deputy Decontamination Manager, at Beaumont Hospital, Dublin, Ireland. He has 15 years’ experience in endoscope decontamination and holds a BSc in Decontamination Management. Kevin was also the winner of B.E.A.I Award in 2020 for project delivery and had QI projects shortlisted at WHFSS 2023 and Irish Health Care Awards in the same year. He is committed to making continual improvements in the space of endoscope decontamination.
Learnings for other departments The biggest takeaway I experienced from overseeing this transition was to try. It may be a simple message, but I believe that if you can do better, you should. Decontamination teams must strive to supply the best quality product available to our service users and, in this case, we can proudly say each patient is receiving a sterile endoscope for every procedure every time. Other learnings came by way of the ‘mystery air supply line’. It is important to ensure project timelines include a buffer to allow for the unexpected. Hospitals are, in essence, a small village. As healthcare professionals, we are lucky to have skilled, knowledgeable colleagues from various backgrounds. You will need to involve as many of these people as possible. The key people on a project team will help with a smooth rollout. I would like to take the opportunity to thank all of those colleagues who supported me in the delivery of this development.
Future plans Beaumont Hospital ENT is now seen as a “proof of concept”. Plans are now underway to allow for the rollout of such a service for all flexible endoscopes in Beaumont Hospital. Technology is moving on and with the introduction of new LTS cycles capable of sterilising long lumened devices, such as colonoscopes, one eye must be kept on the horizon where all endoscopes move to sterility as the desired end point for reprocessing.
CSJ
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